Telephone counseling effectively reaches women with hereditary cancer risk

Telephone counseling provided genetic services for women at high risk for hereditary breast and ovarian cancer as well as in-person counseling, according to the 1-year follow-up of a noninferiority study.

However, participants who received telephone counseling tended to be less likely to undergo genetic testing.

“Increased awareness of associations between BRCA1/2 mutations and breast and ovarian cancer has led to an increased demand for genetic counseling and testing,” Anita Y. Kinney, MSN, PhD, adjunct professor in the divisions of epidemiology and public health at University of Utah School of Medicine, and colleagues wrote. “Telephone counseling can extend the reach of trained genetic counselors and overcome geographic access barriers while reducing costs.”

Concerns exist about whether telephone counseling can assist in informed decision-making and reduce psychologic outcomes as well as in-person counseling. Although short-term data exist that suggest noninferiority between the two methods, long-term data were lacking.

To compare 1-year outcomes of telephone vs. in-person counseling, Kinney and colleagues identified survivors of breast and ovarian cancers who tested positive for BRCA mutations using the Utah Population Database and Utah Cancer Registry. They enrolled 988 (mean age, 56.1 years) female relatives of these survivors who were at risk for breast or ovarian cancers, had personal or family histories meeting genetic testing guidelines, and had not previously undergone BRCA1/2 testing.

Researchers randomly assigned the female relatives to receive in-person counseling (n = 495) or telephone counseling (n = 493) using the same standardized protocol and national guidelines.

Women in the in-person cohort could undergo testing at an appointment or take home a BRCA1/2 buccal test kit, and women in the telephone cohort who decided to undergo testing received a test kit in the mail.

Women in both cohorts received posttest counseling from the same counselor they had previously.

Researchers evaluated 1-year psychosocial, decision-making, quality-of-life and risk management outcomes using one-sided 97.5% CIs. They also evaluated the equivalency of genetic testing uptake between the two groups using a 10% prespecified noninferiority margin by a 95% CI.

Telephone counseling appeared noninferior to in-person counseling for all psychosocial and informed decision-making outcomes, including anxiety (mean difference, 0.08; 97.5% CI, –0.52 to 0.45), cancer-specific distress (mean difference, 0.66; 97.5% CI, –1.75 to 2.28), physical quality of life (mean difference, –0.39; 97.5% CI, –1.35 to 1.06), mental quality of life (mean difference, 0.3; 97.5% CI, –0.83 to 2.26), decisional conflict (mean difference, –0.12; 97.5% CI, –3.69 to 2.03), decisional regret (mean difference, –0.31; 97.5% CI, –4.25 to 2.29) and perceived personal control (mean difference, –0.01; 97.5% CI, –0.06 to 0.06).

In total, 27.6% of participants in the telephone arm and 37.3% of participants in the in-person arm underwent genetic testing (difference, 9.4%; 95% CI, 2.2-16.8). However, this CI fell outside the prespecified equivalency range (95% CI, –10 to 10).

Rural participants had a higher test uptake than urban dwellers in the telephone (38.7% vs. 25.8%) and in-person cohorts (41.3% vs. 36.6%).

“Rural women had higher test uptake rates ... suggesting that BRCA1/2 testing interests were satisfied by expanded access to genetic counseling through the two modalities,” the researchers wrote. “One explanation for this is that urban women most interested in testing may have had access to genetic testing before the study. Many urban women may have been tested and were, therefore, not eligible for this trial. Thus, the urban sample may have been biased toward women who are less interested in testing.”

Researchers acknowledged the generalizability of the findings may be limited because the population was from a single state, was largely non-Hispanic white (94.1%) and had a personal history of cancer.

“This trial provides important evidence that telephone genetic counseling for hereditary breast and/or ovarian cancer is noninferior to in-person counseling and can be delivered as safely as in-person counseling,” Kinney and colleagues wrote. “Telephone counseling can improve access form geographically remote areas, ease the travel and care burden for patients traveling to a clinic, and increase perceived control when patients are given a choice about their preferred counseling mode. – by Nick Andrews

Disclos ure: Kinney reports no relevant financial disclosures. Researchers report consultant/advisory roles for, and honoraria from InVitae and Myriad Genetics.